Nationwide trends of six medications for alcohol use disorder prescriptions post-discharge in patients hospitalized with alcohol-associated liver disease between 2015 and 2024.

INTRODUCTION

Alcohol associated liver disease (ALD) carries a high risk of hospitalization and recidivism, yet post-discharge medications for alcohol use disorder (MAUD) are not universally prescribed. MAUD prescriptions have been associated with reduced recidivism and hepatic decompensation. However, national data on prescribing patterns is limited. We examined ten-year trends in six MAUD prescriptions after hospitalization for ALD.

METHODS

We identified 150,241 US adults hospitalized with ALD between 2015 and 2024 using electronic health records from TriNetX. Outcomes included annual prevalence, incidence rate, and incidence proportion of post-discharge MAUD prescriptions. FDA-approved agents included disulfiram, acamprosate, and naltrexone; off-label agents included topiramate, baclofen, and gabapentin. Trends were assessed using Joinpoint regression with annual percentage change (APC) and average annual percentage change (AAPC). Subgroup analyses were stratified by cirrhosis status and sex.

RESULTS

FDA-approved MAUD had consistently lower prescription rates than off-label agents over the past decade. From 2015-2024, disulfiram was the only FDA-approved agent with a declining trend, while acamprosate (AAPC 20.35%) and naltrexone (AAPC 17.83%) demonstrated significant increases for new prescriptions. By 2024, the prevalence of FDA-approved and off-label MAUD prescriptions were 17.98% and 41.96%, respectively. Patients with cirrhosis had lower prescribing rates but exhibited greater relative increases in FDA-approved MAUD prescriptions. Women were more likely to receive off-label prescriptions, though both sexes showed similar upward trends.

CONCLUSION

Post-discharge MAUD prescribing for ALD has risen significantly, but less than 20% of patients receive FDA-approved MAUD. Expanding access to evidence-based medications is critical to improve outcomes in this high-risk population.